Financial Clearance Representative III - Infusion

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About the position

This position is responsible for verifying eligibility and plan coverage requirements for chemotherapy oncology treatment plans, including pharmaceutical and biosimilar drug formularies. This position is also responsible for verifying patient insurance, confirming benefits eligibility, performing authorization and pre-certification, calculating and estimating patient liability, and/or notification as required by third party coverage providers. Purpose of this job is to verify that TriHealth patient insurance information is accurate and up to date so payment will be received for services rendered. This position requires basic knowledge and understanding of pharmaceutical drug prior authorizations and infusion services. Additionally, this position requires the knowledge to review medical records obtaining information such as diagnosis, prior treatment, sign and symptoms, medication and other medical information to submit requests for authorizations for surgery, testing or treatment. THIS WORK FROM HOME ROLE REQUIRES A GREATER CINCINNATI BASED TEAM MEMBER.

Requirements

  • High School Degree in Medical terminology course or equivalent knowledge
  • Knowledge of Medical Terminology
  • Insurance vocabulary and processes
  • Government and non-government third party benefits and coverage rules
  • Understanding of the impact financial clearance services has on revenue cycle operations and financial performance
  • 1-2 years experience with treatment/therapy plans
  • 1-2 years experience with pharmaceutical formularies and basic understanding of biosimilar formularies
  • 1-2 years experience Customer Service Healthcare Dedication to treating both internal and external constituents as clients and customers
  • Maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality
  • Background in managed care or patient billing
  • 1-2 years experience Technical Healthcare
  • Must have one year experience in insurance verification or precertification experience
  • Experience with automated patient account system or online verification systems
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